MCS Classicare Hero (HMO) 2025 Plan Details for Patillas Municipio, Puerto Rico Residents
MCS Classicare Hero (HMO) 2025 Plan Details for Patillas Municipio, Puerto Rico Residents
Choosing the right Medicare Advantage plan in Patillas Municipio is crucial for your healthcare needs in 2025. With MCS Classicare Hero (HMO) as one of the options, you can compare it side-by-side with other available plans to find the best fit for you. Whether you prefer enrolling online or seeking advice from a licensed agent, we’ve made the process simple and straightforward.
According to CMS enrollment data (May, 2025), there are approximately 5,114 members enrolled in this plan, 17 in Patillas Municipio.
MCS Classicare Hero Overview
| Plan ID H5577-044-0 Overview | |
|---|---|
| Health Plan ID: | H5577-044-0 |
| Medicare Advantage Plan Type: | HMO |
| Plan Year: | 2025 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $3,400.00 (In-Network) |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Enhanced, $0.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Patillas Municipio, PR |
| Insured By: | MCS Classicare |
Why Choose MCS Classicare Hero ?
This Medicare Advantage Prescription Drug (MAPD) HMO plan delivers comprehensive coverage, including hospital care, medical services, and prescription drugs — all under one roof. With a monthly premium of $0.00, you’ll get the core benefits of Medicare Part A and Part B, plus drug coverage to manage ongoing prescriptions. The annual Part D deductible is $0.00. Like most HMO plans, you’ll be asked to use in-network providers unless it’s an emergency.
Primary care visits have a $11 copay, specialist visits come with a $20 copay, urgent care services carry a not covered, and ambulance transportation is not covered. These costs all apply toward the plan’s annual maximum out-of-pocket (MOOP) limit of $3,400.00 . Once you hit that threshold, in-network services are fully covered for the rest of the year — helping you plan your healthcare spending with confidence.
CMS recognizes this plan as H5577-044-0. You’ll find a summary of its cost sharing below, including what you can expect to pay for primary care, specialists, urgent care, and more. Still have questions? Check the FAQ section for more details.
| We're Here to Help You Enroll |
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Cost-Sharing Overview
MCS Classicare Hero includes cost-sharing, which refers to the out-of-pocket expenses you'll incur when accessing approved healthcare services. The table below outlines the most common in-network out-of-pocket costs for plan H5577-044-0.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | $11 Copay |
| Specialist: | $20 Copay |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $75 Copay |
| Urgent care: | Not Covered |
| Ground ambulance: | Not Covered |
| Inpatient hospital care: | $100.00 per stay |
| Skilled Nursing Facility: |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $20 Copay |
| Routine Foot Care: | Not Covered |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $20 Copay Prior Authorization Required |
| Routine chiropractic: | Not Covered |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | Not Covered |
| Outpatient group therapy: | Not Covered |
| Inpatient psychiatric hospital care: |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | Not Covered |
| Occupational therapy: | Not Covered |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | Not Covered |
| Durable medical equipment: | Not Covered |
| Prosthetics: | 20% Coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | 20% Coinsurance Prior Authorization Required |
| Lab services: | 20% Coinsurance Prior Authorization Required |
| Outpatient x-rays: | Not Covered |
| Diagnostic tests and procedures: | 20% Coinsurance Prior Authorization Required |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered): | 20% Coinsurance |
This section details the dental services covered under your plan including, Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Medicare Covered Preventive Dental | Not Covered |
| Oral exam | |
| Dental x-rays | |
| Cleaning | |
| Periodontics | |
| Endodontics | |
| Restorative Services |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | Covered Limits may apply |
| Hearing aids | Covered Limits may apply |
| Hearing exam | Covered Limits may apply |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | |
| Routine eye exam (in-network) | Covered Limits may apply |
| Eyewear benefits | Eyeglasses: Yes Contact Lenses: Yes Eyeglass Lenses: Yes Eyeglass Frames: Yes Eyewear Upgrades: Yes |
Maximum eyewear benefit: | $725.00 Every year |
Certain preventive services are covered 100% by MCS Classicare Hero as a Part B benefit.
Part D Prescription Drug Costs & Benefits
MCS Classicare Hero includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
| Basic Part D Premium: | $(52.40) |
|---|---|
| Supplemental Part D Premium: | $52.40 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | ${part_d_lips_amount} |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program.
Prescription Drug Plan Deductible
This plan has a $0.00 annual Part D deductible. You'll pay this deductible at the pharmacy before MCS Classicare starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, MCS Classicare Hero may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 | $0.00 |
| Generic | $0.00 | $0.00 |
| Preferred Brand | $5.00 | $0.00 |
| Non-Preferred Brand | $15.00 | $0.00 |
| Specialty Tier | 33.00% | 0.00% |
| Select Care Drugs | $0.00 | $0.00 |
| *Deductible does not apply. | ||
CMS 5-Star Rating Overview
The Centers for Medicare & Medicaid Services (CMS) reviews and rates Medicare Advantage (Part C) and drug plans (Part D) annually, using a 5-star system to measure aspects such as member satisfaction, preventive services, and management of chronic conditions.
Higher star ratings generally indicate better plan performance, which can be a useful factor to consider when deciding on a plan that aligns with your healthcare goals and preferences.
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Who Can Enroll in MCS Classicare Hero ?
To qualify for enrollment in MCS Classicare Hero , you must:
- Be entitled to Medicare Part A and enrolled in Medicare Part B.
- Live within the plan’s designated service area.
If you fulfill these criteria, you can enroll in MCS Classicare Hero and enjoy the extensive healthcare benefits it offers.
When Can I Enroll in MCS Classicare Hero ?
Understanding the right time to enroll in MCS Classicare Hero is crucial. Here are the key enrollment periods:
- Initial Enrollment Period (IEP): Your first opportunity to enroll in Medicare starts three months before your 65th birthday and lasts until three months after your birthday month.
- Annual Enrollment Period (AEP): Occurring annually from October 15 to December 7, the AEP allows you to enroll in, switch, or drop a Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31 each year, the MA OEP gives you the chance to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing other coverage, may make you eligible for a SEP, allowing you to adjust your plan outside the usual periods.
Not sure when to enroll? Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) to speak with a licensed insurance agent who can guide you through your options.
How to Sign Up for MCS Classicare Hero
Joining MCS Classicare Hero is straightforward. Here are the steps you can take:
- Online: Use our online enrollment partner's Secure Online Enrollment Form to sign up.
- By Phone: Reach out to HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent will help you with the enrollment process and answer any questions you might have.
- Through Medicare.gov: Enroll directly through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the steps to join MCS Classicare Hero .
- Direct Enrollment: You can also choose to enroll directly with MCS Classicare Hero . The contact information can be found below in the "Contact" section.
Make sure you enroll during the appropriate period to activate your coverage as soon as possible.
Here are some of the most frequently asked questions people have about plan ID H5577-044-0:
What’s the monthly premium for MCS Classicare Hero (HMO)?
Members pay their Part B premium and the plan's of $0.00 per month to be in this 2025 plan.
What’s the MOOP for MCS Classicare Hero in 2025?
The annual in-network MOOP is $3,400.00 , protecting you from larger bills once you hit that limit.
What’s the prescription-drug deductible for 2025?
Yes. The Part D deductible is $0.00. The plan does not have a drug tier without a deductible.
What’s the CMS star score for MCS Classicare Hero ?
The latest CMS score is ★5.0 out of 5 stars; anything 4 or higher earns quality bonuses.
Is MCS Classicare Hero popular?
CMS reports 5,114 members in the latest file.
Contact MCS Classicare
| Website: | MCS Classicare Plan Page |
|---|---|
| Providers: | MCS Classicare Providers Page |
| Formulary: | MCS Classicare Formulary Page |
| Pharmacy: | MCS Classicare Pharmacy Page |
| New Member Health Plan Help: | (866)591-4002 |
| New Member Health Plan TTY: | (866)627-8182 |
| New Member Part D Help: | (866)591-4002 |
| New Member Part D TTY Users: | (866)627-8182 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- MCS Classicare, http://www.mcsclassicare.com, Last Accessed June 1, 2025
- Medicare.gov, "Compare types of Medicare Advantage Plans", Last Accessed 25 May, 2025
- AARP.org, "The Big Choice: Original Medicare vs. Medicare Advantage", Last Accessed 25 May, 2025
- Medicare.gov, "Your coverage options", Last Accessed 25 May, 2025
- CMS.gov, Landscape Source Files, Last Accessed October 15, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 15, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 15, 2024
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County, Last Accessed June 6, 2025
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